Stroke complications may subtract additional two years of healthy life

· Stroke complications may deprive patients of about two
years of healthy life, in addition to three years of healthy life
lost due to the stroke, according to a South Korean study.

· A combined measure of potential life years and function
lost can impact public health decisions, researchers said.

· However, it’s unclear if the findings can be
applied to other populations.

DALLAS, July 1, 2010 — Complications shortly after a stroke
deprive patients of about two years of healthy life — in
addition to the toll of stroke, according to research reported in
Stroke: Journal of the American Heart Association.

Findings from the Complication in Acute Stroke Study (COMPASS)
are based on data from more than 1,200 patients (average age 66)
treated at four South Korean university hospitals in 2004-05. All
patients had an acute ischemic stroke, which results when a blood
vessel supplying the brain is blocked.

Researchers gauged the impact of stroke and its complications
using disability-adjusted life years (DALY) measures of age, gender
and disability level. DALY combines years of life lost with years
of healthy life lost due to disability. They calculated DALY lost
due to stroke and additional DALY lost due to stroke
complications.

The average DALY lost for stroke survivors was 3.82 years. When
researchers assessed the effect of complications after stroke, they
found that average DALY for those without­ complications was
3.10 years. However, patients suffering any of a range of
complications — about a third of all subjects — lost an
average of 5.21 DALY, a difference of 2.1 healthy life years.

Other research gauging stroke’s burden has focused either
on loss of potential life or loss of function. “This study
delineates the burden of post-stroke complications with a more
comparable and more understandable scale — healthy life years
lost,” said Keun-Sik Hong, M.D., Ph.D., lead author of the
study and associate professor at Inje University in South
Korea.

DALY, a measure of global disease burden devised by the World
Health Organization, can yield consistent comparisons between the
impact of stroke and other medical conditions and provide insights
on treatments’ benefits. “Accordingly, this scale helps
public health policy decision-makers to allocate limited resources
based on a more scientific judgment,” Hong said.

Almost 34 percent of patients experience some complication
within four weeks of their stroke, including stroke progression,
pneumonia, urinary tract infection, additional stroke, seizure, or
heart attack.

Patients with one complication lost 1.52 additional DALY on
average, while patients with two or more complications lost 2.69
DALY.

Almost half the complications developed within two days of the
stroke, including half the cases of pneumonia and 65 percent of the
instances of ischemic stroke progression, Hong said.

Among limitations of the study:

· It may underestimate the frequency of complications
because patients whose stroke had occurred up to a week earlier
were included, even though they weren’t yet subject to
hospital observation and care.

· The findings might not apply broadly to the Korean
stroke population, or others, because patients were receiving care
only in university hospital settings in South Korea.

Having a simple measure to convey the burden of post-stroke
complications and the importance of best-practice care can greatly
impact hospital and public health decision-making, the researchers
said. Formal screening for dysphagia, a swallowing disorder that
often results from stroke, can cut risk of developing pneumonia in
half. Patients who are spared pneumonia avoid a potential average
loss of 2.14 disability-adjusted life years.

Other components of organized stroke care include early
rehabilitation and prevention of deep vein thrombosis, clotting in
the deep veins such as in the legs, which has potentially fatal
complications.

The U.S. National Institutes of Health and the American Heart
Association funded the study.

###

Statements and conclusions of study authors published in
American Heart Association scientific journals are solely those of
the study authors and do not necessarily reflect the
association’s policy or position. The association makes no
representation or guarantee as to their accuracy or reliability.
The association receives funding primarily from individuals;
foundations and corporations (including pharmaceutical, device
manufacturers and other companies) also make donations and fund
specific association programs and events. The association has
strict policies to prevent these relationships from influencing the
science content. Revenues from pharmaceutical and device
corporations are available at
www.americanheart.org/corporatefunding.

Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment.